Preparing For Omicron And Future Variants: Our Toolkit For Covid-22 Can’t Be The Same As The One For Covid-19

It‘s already two years since the first official case of Covid-19 was detected in China’s Wuhan. The operating word being ‘official’ given it’s China we are dealing with. As per a US intelligence report, three researchers from China’s Wuhan Institute of Virology had become sick enough back in November 2019 itself that they sought hospital care. Nonetheless, we may never know the reality.

As we are on the verge of entering into 2022, threat of Omicron, the latest SARS-CoV-2 lineage to be termed as a variant of concern (VOC) by the World Health Organisation, looms large. The WHO’s alacrity about it can be gauged from the fact that it was termed a VOC within a week of identification and reporting of its lineage (B.1.1.529) to the Pango network.

Pango is a network of researchers and is used for identifying and naming lineages of SARS-CoV-2. Note that it took the WHO more than a month to do the same in case of the previous deadly variant Delta, which wreaked havoc in form of the second wave in India at its peak in April and May.

The alarm over Omicron is not without reason. As the below graph proves, its very much warranted as far as the sheer number of cases are concerned. The lower numbers of hospitalisation and deaths in Omicron wave as compared to Delta one might be because of vaccines as well as due to less virulence of the variant itself.

In such a scenario, lowering our guard is not an option. But unfortunately, we seem to be repeating the same mistakes that helped fuel the previous wave. I had hoped that three things would happen post the second wave:

First, vaccine hesitancy will be much less even in rural areas which have been hit the hardest this time.

Second, people will not underestimate the virus anymore and lower their guard as they did after witnessing low caseload and deaths in the first wave.

Third, and this is more of a hope, the governments will ensure that there is mask compliance and social distancing measures are not violated with impunity in addition to ramping up medical infrastructure to prepare for even a bigger third wave.

As of now, one can claim that only the first prediction turned out to be true because people as well as the government are as lax as ever as if the devastating scenes of April-May period have been completely forgotten.

The number of people wearing masks has come down considerably. Social distancing is non-existent and there is total absence of any government concern to enforce its own guidelines. One can understand that people can’t keep wearing masks forever and social distance is not always possible in a densely populated country like India but these regulations need to be enforced in letter and spirit whenever threat of a highly infectious or deadly variant emerges. When the threat subsides, relaxations can be made.

As far as ramping up medical infrastructure is concerned, though the Centre took a big step of setting up hundreds of oxygen plants, one is not sure if these have actually started functioning. In Parliament, when the Union Ministry for Health and Family Welfare was asked about ‘the total number of Pressure Swing Adsorption (PSA) oxygen plants that are currently functioning along with the total target for setting up PSA plants, State/UT wise and District wise‘, the ministry didn’t give a direct answer about how many plants were actually functional and rather answered that 1463 plants have been commissioned.

It was asked a more pointed question by another Member of Parliament which enquired about the date of installation of each of these plants and if they are functional or not. However, it elicited same response about the number of commissioned plants. This either means that the plants have not become functional yet or the ministry is itself not aware of their status.

The silver lining in all this is that compared to last year, overall daily medical oxygen production capacity has increased by almost 2,000 MT thanks to the second wave. However, it’s important that the PSA plants are up and running as they can support oxygen needs of one lakh patients per day.

One of the biggest reasons for deaths and hospitalisations during the Delta variant-led second wave was low incidence of vaccination in the country. In countries which had wide vaccination coverage, Delta’s impact was much milder. Thankfully, we now have over 85 per cent people inoculated with at least one dose and by the end of this month, at current pace of administration of second doses we would have almost 65 percent adults fully vaccinated. That’s a fantastic achievement given the size of our population.

While this will be a big factor in lessening the impact of Omicron or other future variants as far as deaths and hospitalisations are concerned, scientific evidence so far suggests that there will be breakthrough infections. More importantly, healthcare workers, frontline workers and those above 60 and population with co-morbidities were the first to be dosed and it’s been more than six months since most of them got their vaccines which means that it’s highly likely that their antibodies level have fallen. These groups need to be prioritised for booster doses and their drive initiated as soon as possible. The importance of protecting these vulnerable groups can’t be overemphasised.

Unfortunately, we will have to rely on boosters to prevent severe disease at least when faced with a threat of a new wave and as long as we don’t have a sterilising vaccine (perhaps, nasal vaccines will be key in preventing transmission).

Testing was another big failure during the second wave with test positivity rates rising over 35-40 per cent in worst hit places like Delhi and turnaround time from testing to result of 3-4 days which meant that treatment was delayed and resulted in more severe disease by the time people got their result.

The virus is an invisible enemy which can be ‘seen’ only by the power of testing. That’s the most important thing in the fight against it. Still and despite the unpleasant experience of the second wave, it’s a mystery why rapid test kits for people to test themselves at home or for the businesses (or schools) to do so at workplaces aren’t widely available.

The current test kits are priced too high to make them available to tens of millions on demand.

Testing also helps us track super-spreaders and quarantine them early before they infect others in their family. The state needs to understand that it needn’t do all the heavy lifting. Individuals or local communities can be trusted as well. Personal responsibility towards family and friends will be enough of a barrier for most to test themselves frequently and isolate in case they are positive.

The investment needed by the government on this front is not even a fraction of what the country will pay in terms of lockdowns, curfews, etc when or if the third wave hits. The technology is already there. Scaling will ensure that it's cheap enough to be afforded by individuals and businesses.

To sum up, the governments need to do these things to be on top preparedness levels to tackle the challenge of Omicron or any other future variants.

Compliance of masks and social distancing measures need to be enforced strictly. Super-spreader events like election rallies, crowds at cricket marches and other such events need to be stopped. Booster doses for the vulnerable groups have to be administered on priority. Additionally, there should be increased investment in making rapid test kits widely available.

We can’t afford to be lax and let a third wave rip through the population again. It’s time to get serious otherwise there will be huge cost to pay.